Individual
LORRAINE WISNIESKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
200 WIRELESS BLVD, HAUPPAUGE, NY 11788-3974
(631) 853-7373
Mailing address
2 LONGWOOD DR, HUNTINGTON STATION, NY 11746-4716
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
297848-1
NY
Other
Enumeration date
04/15/2015
Last updated
04/15/2015
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